Sheffield Teaching Hospitals NHS Trust

Sheffield, United Kingdom

Sheffield Teaching Hospitals NHS Trust

Sheffield, United Kingdom
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Egner W.,Sheffield Teaching Hospitals NHS Trust
Journal of Clinical Pathology | Year: 2016

Background Sheffield National Adverse Reactions Consultancy Service (NARCOS) investigates and triages suspected perioperative anaesthetic reactions to allergy clinics, using serial tryptase samples, urinary methylhistamine and clinical information on a pro forma request. Objective To determine if current UK guidelines on serial tryptase samples are achieved and describe the patterns of tryptase release. Method A retrospective review of 3455 NARCOS cases. Tryptase and clinical details were analysed. 1746 had sufficient clinical information to grade the reactions according to the Ring and Messmer scale. Results 98% provided two or more acute samples, but only 60% supplied clinical information. 308 patients never dropped within the reference range over three samples. Conclusions Good compliance with UK guidelines for tryptase measurements is achievable in this long-term cohort, but obtaining clinical details at referral remains a challenge. Sample sequence labelling and apparent timing may be misleading. Baseline tryptase may frequently need to be rechecked in allergy clinics to estimate true peak-to-trough changes. © 2016 by the BMJ Publishing Group Ltd & Association of Clinical Pathologists.

Shrestha B.M.,Sheffield Teaching Hospitals NHS Trust
Experimental and Clinical Transplantation | Year: 2017

Tacrolimus, a calcineurin inhibitor, has been the cornerstone of immunosuppressive regimens in renal transplant over 2 decades. This has significantly improved the outcomes of renal transplant, including reduction of acute rejection episodes, improvement of renal function and graft survival, and reduction of some of the adverse effects associated with cyclosporine. However, use of tacrolimus is associated with a number of undesirable effects, such as nephrotoxicity, posttransplant diabetes mellitus, neurotoxicity, and cosmetic and electrolyte disturbances. To alleviate these effects, several strategies have been adopted to minimize or eliminate tacrolimus from maintenance regimens of immunosuppression, with some success. This review focuses on advancements in the understanding of the basic science related to tacrolimus and the clinical evidences that have examined the efficacy and safety of tacrolimus in renal transplant over the past 2 decades and highlights the future directions. © Başkent University 2017 Printed in Turkey. All Rights Reserved.

Quaife N.M.,Sheffield Teaching Hospitals NHS Trust | Quaife N.M.,University of Sheffield | Watson O.,Sheffield Teaching Hospitals NHS Trust | Watson O.,University of Sheffield | And 2 more authors.
Current Opinion in Pharmacology | Year: 2012

The zebrafish has attracted interest from both the scientific and general press owing to its transition from a model of developmental biology to a tool for biomedical and preclinical studies. In this brief review, we summarise the advantages of a unique model organism and outline some of its recent contributions to the understanding of vascular development and remodelling. © 2012 Elsevier Ltd.

Mangera A.,Sheffield Teaching Hospitals NHS Trust | Apostolidis A.,Aristotle University of Thessaloniki | Andersson K.E.,Wake forest University | Dasgupta P.,King's College London | And 4 more authors.
European Urology | Year: 2014

Context Botulinum toxin A (BoNTA) has received regulatory approval for use in neurogenic detrusor overactivity (NDO) and overactive bladder (OAB), but it remains unlicensed in other lower urinary tract symptoms (LUTS) indications such as nonneurogenic LUTS in men with benign prostatic enlargement (LUTS/BPE), bladder pain syndrome (BPS), and detrusor sphincter dyssynergia (DSD). Objective To compare statistically the outcomes of high level of evidence (LE) studies with placebo using BoNTA for LUTS indications; NDO, OAB, LUTS/BPE, BPS and DSD. Evidence acquisition We conducted a systematic review of the published literature on PubMed, Scopus, and Embase reporting on BoNTA use in LUTS dysfunction. Statistical comparison was made between high LE studies with placebo and low LE studies. Evidence synthesis In adult NDO, there are significantly greater improvements with BoNTA in daily incontinence and catheterisation episodes (-63% and -18%, respectively; p < 0.01), and the urodynamic parameters of maximum cystometric capacity (MCC), reflex volume, and maximum detrusor pressure (MDP) (68%, 61%, and -42%, respectively; all p < 0.01). In OAB, BoNTA leads to significant improvements in bladder diary parameters such as daily frequency (-29%), daily urgency (-38%), and daily incontinence (-59%) (all p < 0.02). The urodynamic parameters of MCC and MDP improved by 58% (p = 0.04) and -29% (p = 0.002), respectively. The risk of urinary tract infection was significantly increased from placebo at 21% versus 7% (p < 0.001), respectively; the risk of intermittent self-catherisation increased from 0% to 12% (p < 0.001). Men with LUTS/BPE showed no significant improvements in International Prostate Symptom Score, maximum flow rate, or prostate volume. There were insufficient data for statistical analysis in DSD, BPS, and paediatric studies. Low LE studies were found to overestimate the effects of BoNTA in all indications, but differences from high LE studies were significant in only a few parameters. Conclusions BoNTA significantly improves all symptoms and urodynamic parameters in NDO and OAB. The effect of BoNTA in treating LUTS dysfunction appears to be overestimated in lower as opposed to higher LE studies. © 2013 European Association of Urology.

Mangera A.,Sheffield Teaching Hospitals NHS Trust | Andersson K.-E.,Wake forest University | Apostolidis A.,Aristotle University of Thessaloniki | Chapple C.,Sheffield Teaching Hospitals NHS Trust | And 4 more authors.
European Urology | Year: 2011

Context: The use of botulinum toxin A (BoNTA) in the treatment of lower urinary tract dysfunction has expanded in recent years and the off-licence usage list includes neurogenic detrusor overactivity (NDO), idiopathic detrusor overactivity (IDO), painful bladder syndrome (PBS), and lower urinary tract symptoms resulting from bladder outflow obstruction (BOO) or detrusor sphincter dyssynergia (DSD). There are two commonly used preparations of BoNTA: Botox (onabotulinumtoxinA) and Dysport (abobotulinumtoxinA). Objective: To compare the reported outcomes of onabotulinumtoxinA and abobotulinumtoxinA in the treatment of NDO, IDO, PBS, DSD, and BOO for adults and children. Evidence acquisition: We performed a systematic review of the published literature on PubMed, Scopus, and Embase in the English language reporting on outcomes of both BoNTA preparations. Review articles and series with <10 cases were excluded. The articles were graded for level of evidence and conclusions drawn separately for data with higher-level evidence. Evidence synthesis: There is high-level evidence for the use of onabotulinumtoxinA and abobotulinumtoxinA in adults with NDO but only for abobotulinumtoxinA in children with NDO. Only onabotulinumtoxinA has level 1 evidence supporting its use in IDO, BOO, DSD, and PBS/interstitial cystitis. Conclusions: We identified good-quality studies that evaluated onabotulinumtoxinA for all the indications described above in adults; such was not the case with abobotulinumtoxinA. Although this does not imply that onabotulinumtoxinA is more effective than abobotulinumtoxinA, it should be a consideration when counselling patients on the use of botulinum toxin in urologic applications. The two preparations should not be used interchangeably, either in terms of predicting outcome or in determining doses to be used. © 2011 European Association of Urology.

Theodorou N.,Sheffield Teaching Hospitals NHS Trust | Burke J.,Sheffield Teaching Hospitals NHS Trust
British Journal of Ophthalmology | Year: 2013

Aims: To evaluate the outcomes following surgery on patients with bilateral Duane's Retraction Syndrome (DRS) associated with exotropia or exophoria. Methods: Eleven consecutive patients with exotropic DRS were identified in a 10-year period. The case notes were reviewed, and data was analysed to evaluate the results following surgery. The preoperative and postoperative outcomes were evaluated for the angle of deviation in primary position, abnormal head posture, stereovision for near-fixation and horizontal ocular ductions. Results: All patients had a significant improvement in their angle of deviation in primary position, and 82% had a residual angle within 10 prism dioptres of orthotropia/phoria (p<0.001). For those patients with abnormal head posture, 86% resolved or improved. The postoperative cumulative horizontal ocular ductions measured less in nine patients by an average of 1.5 units. Pre-existing near-stereovision improved in 83% of the patients by an average of 40″ arc. Conclusions: Surgery for bilateral exotropic DRS resulted in an improvement in the primary position angle and abnormal head posture. Patients demonstrated reduced cumulative horizontal ocular ductions restrictions and enhanced near-stereovision. This case series on exotropic bilateral DRS provides further evidence into successful postoperative surgical and functional outcomes.

Storey P.,Sheffield Teaching Hospitals NHS Trust | Gadd R.J.,Sheffield Teaching Hospitals NHS Trust | Blundell C.,Sheffield Teaching Hospitals NHS Trust | Davies M.B.,Sheffield Teaching Hospitals NHS Trust
Foot and Ankle International | Year: 2012

Background: The TightRope® is a relatively new device designed to stabilize ankle syndesmotic injuries. There are no studies evaluating the clinical effectiveness of this technique and few reports addressing complications and potential modifications to the surgical technique reported in this article. Materials and Methods: A retrospective review of 102 cases of traumatic ankle syndesmotic stabilization using the TightRope device is presented. Patients were followed up for a median of 85 days after surgery. Results: Eight patients subsequently had the TightRope removed. This was performed for four reasons: osteomyelitis surrounding the implant, painful aseptic osteolysis surrounding the implant, failed stabilization of the syndesmosis, and unexplained pain. Conclusions: On the basis of experience, the authors recommend meticulous attention during the surgical technique. To prevent skin irritation and stitch abscess formation leading to osteomyelitis, the FiberWire loop is best cut with a knife at least 1 cm beyond the knot, allowing the sharp end of the FiberWire to lay flat adjacent to the fibula. Painful aseptic osteolytic reaction to the TightRope necessitates removal. To prevent rediastasis, a small medial incision is recommended for endobutton positioning directly abutting the tibial cortex without soft tissue interposition. Inserting the TightRope through a fibula plate prevents lateral button pull-through and rediastasis. Copyright © 2012 by the American Orthopaedic Foot & Ankle Society.

Mangera A.,Sheffield Teaching Hospitals NHS Trust | Chapple C.R.,Sheffield Hallam University
Asian Journal of Andrology | Year: 2013

The field of tissue engineering is rapidly progressing. Much work has gone into developing a tissue engineered urethral graft. Current grafts, when long, can create initial donor site morbidity. In this article, we evaluate the progress made in finding a tissue engineered substitute for the human urethra. Researchers have investigated cell-free and cell-seeded grafts. We discuss different approaches to developing these grafts and review their reported successes in human studies. With further work, tissue engineered grafts may facilitate the management of lengthy urethral strictures requiring oral mucosa substitution urethroplasty. © 2013 AJA, SIMM & SJTU.

Williams D.P.,University of Oxford | Blakey C.M.,Sheffield Teaching Hospitals NHS Trust | Hadfield S.G.,Epsom General Hospital | Murray D.W.,University of Oxford | And 2 more authors.
Journal of Bone and Joint Surgery - Series B | Year: 2013

The Oxford knee score (OKS) is a validated and widely accepted disease-specific patient-reported outcome measure, but there is limited evidence regarding any long-term trends in the score. We reviewed 5600 individual OKS questionnaires (1547 patients) from a prospectively-collected knee replacement database, to determine the trends in OKS over a ten-year period following total knee replacement. The mean OKS pre-operatively was 19.5 (95% confidence interval (CI) 18.8 to 20.2). The maximum post-operative OKS was observed at two years (mean score 34.4 (95% CI 33.7 to 35.2)), following which a gradual but significant decline was observed through to the ten-year assessment (mean score 30.1 (95% CI 29.1 to 31.1)) (p < 0.001). A similar trend was observed for most of the individual OKS components (p < 0.001). Kneeling ability initially improved in the first year but was then followed by rapid deterioration (p < 0.001). Pain severity exhibited the greatest improvement, although residual pain was reported in over two-thirds of patients post-operatively, and peak improvement in the night pain component did not occur until year four. Post-operative OKS was lower for women (p < 0.001), those aged < 60 years (p < 0.003) and those with a body mass index > 35 kg/m2 (p < 0.014), although similar changes in scores were observed. This information may assist surgeons in advising patients of their expected outcomes, as well as providing a comparative benchmark for evaluating longer-term outcomes following knee replacement. © 2013 British Editorial Society of Bone & Joint Surgery.

Keriakos R.,Sheffield Teaching Hospitals NHS Trust | Chaudhuri S.,Sheffield Teaching Hospitals NHS Trust
Journal of Obstetrics and Gynaecology | Year: 2012

In many recent studies in the developed world, the incidence of postpartum haemorrhage (PPH) has been rising, though the mortality has come down, suggesting improvement in the management of this condition. Since the publication of the RCOG guidelines in 2009 for management of PPH and the Sheffield guidelines for the use of Rusch balloon along with the initial small case series (Keriakos and Mukhopadhyay 2006), many units have introduced the guidelines into clinical practice. This has led to the reduction of surgical intervention in our unit. Major PPH accounted for 1.6% of the total deliveries in our hospital. Surgical interventions accounted for 7.8% of these cases and only 0.1% of the total deliveries. Risk factors for PPH were identified in 83%. In this paper, we reviewed the management of all patients who had major PPH and failed medical management over a period of about 4 years. All surgical interventions including Rusch balloon, B-Lynch suture, radiological interventions and hysterectomy were described. An update to Rusch balloon guidelines and Sheffield guidelines for management of major PPH are appended. © 2011 Informa UK, Ltd.

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